DESCRIPTION: The proposal has four aims: (1) to describe the functional and clinical characteristics of patients admitted to SNF with a diagnosis of hip fracture or stroke, as well as the outcomes they experience over the subsequent year, and the relationship of these outcomes to the patient's main reason for admission (rehabilitation versus skilled nursing versus high technology treatment) and to the rehabilitation orientation of the SNF; (2) to compare the relative effectiveness of specific post-acute treatment options in terms of rehospitalizations, additional service use, permanent placement in the nursing home, and mortality; (3) to validate a new methodology for identifying new-SNF nursing home stays; and (4) to examine the relationship between patients' functional status at the time of discharge from the nursing home on subsequent health service utilization. The sample for the first three aims will consist of patients admitted to a SNF after hospitalization for hip fracture or stroke in the case-mix demonstration states of Maine, South Dakota, New York, Kansas, and Mississippi. The sample will be limited to Medicare beneficiaries aged 70 years or older and admitted in 1992-1995. The sample for Aim 4 will consist of all available patients admitted to 124 National Health Corporation-owned and managed nursing homes. This sample is unique in having MDS assessments for functional status performed on discharge from the nursing home. It is estimated that the MDS sample will include 16,800 stroke patients and 19,600 hip fracture patients (for Aims 1-3). It is estimated that the National Health Corporation sample will include at least 7,400 stroke patients and 6,800 hip fracture patients. Four outcomes will be examined: death, rehospitalization, additional utilization (defined as the total number of services the patient encountered from the network of care after completing the post-acute treatment phase), and permanent nursing home placement. Independent variables at the level of the person, facility, county, and state will be examined.